Dogs Can Dance - Printed Registration Form

To register - Please fill in completely then Print and mail this form with full payment.
Class ID:
   240 - Intro to Freestyle Workshop
Date:
   Sunday, March 26, 2017 - One Day Class
Time:
   10:30 am - 12:00 noon
Class Fee:
   $ 45.00       Audit Only Fee: $ 25.00 (Choose one)
Notes:
   $80 if registering for the full day of workshops. Checks, Major Credit Cards, or request a paypal invoice by contacting Info@DogsCanDance.com
Location:
  

P.D. Pitchford Companion Animal Villege and Ed Cnt
7700 East Spring Street
Long Beach, CA 90815

     
Please Enter the following information
First Name:
  
Last Name:
  
Street: :
  
Unit/Apt Num::
  
City:
  
State:
  
Tel:
  
Email:
  
     
Dog's Name:
  
Dog Breed:
  
Payment Information:   Visa M/C
 
Name:
  
Card Number:
  
Expiration Date:
  Month Year    
Security Code:
  (3 digits - back of card)
Amount Total :   $_________________
Note: Telephone number or e-mail address required for ALL credit card orders. For your security we do not keep any credit card information on file. Once the order is processed, we destroy all credit card information.
     

Liability Waiver: I agree to hold harmless Dogs Can Dance LLC, Judy Gamet, and the owners of P.D. Pitchford Companion Animal Villege and Ed Cnt in the event of an injury prior to, during, or after the workshop or classes. I understand that my only reimbursement in the event of an injury is my own insurance.

*Signature ___________________________________ Date_______________

This Form created on Friday, 19 April 2024 02:12 pm


Fill in, print, and mail the form along with all applicable fees to -

Dogs Can Dance
 Dogs Can Dance
 PO Box 2117
Vacaville, CA 95696